Child Abuse

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Child Abuse

• Dr. Rasha Salama
• PhD Community Medicine
• Suez Canal University
• Egypt

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So long as little children are allowed to
suffer, there is no true love in this
world Duncan
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Children Rights

• There is clear evidence that child abuse is a
  global problem. It occurs in a variety of forms
  and is deeply rooted in cultural, economic and
  social practices.
• Before defining child abuse its crucial to get
  informed about childrens rights in the first
  place.
• According to the National Council for Childhood
  and Motherhood (NCCM) in Egypt, Egyptian children
  are a national priority.

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NCCMS RIGHTS BASED APPROACH(Convention on the
Rights of the Child)

• Non-discrimination (article 2)
• Best interests of the child (article 3)
• Life, survival and development (article 6)
• Respect of the views of the child (article 12)

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PRIORITIESRight to Education

• Access to quality, free, compulsory primary
  education.
• Non-Discrimination in access to education (gender
  gap).
• (Aims of Education art. 29)
• Right to leisure, recreation and cultural
  activities.

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Right to Health

• Access to quality health services
• Rights of children with disabilities
• Adolescents and reproductive health knowledge
• Right to benefit from social security
• Right to an adequate standard of living

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Right to Special Protection

• Protection from all forms of exploitation
  (economic, sexual).
• Violence against children (physical,
  psychological sexual).
• Female Genital Mutilation early marriage.
• Torture and deprivation of liberty for juvenile
  in conflict with the law
• Hazardous occupations.
• Smoking, substance abuse, and trafficking.
• Street children.

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Child Abuse

In 1999, the WHO Consultation on Child Abuse
Prevention compared definitions of abuse from 58
countries and drafted the following
definition Child abuse or maltreatment
constitutes all forms of physical and/or
emotional ill-treatment, sexual abuse, neglect or
negligent treatment or commercial or other
exploitation, resulting in actual or potential
harm to the childs health, survival, development
or dignity in the context of a relationship of
responsibility, trust or power.
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Definition of Child Abuse

• The physical or mental injury, sexual abuse or
  exploitation, negligent treatment, or
  maltreatment of a child under the age of 18 by a
  person who is responsible for the childs welfare
  under circumstances which indicate that the
  childs health or welfare is harmed or
  threatened.
• 
  Child Welfare Act

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Another Definition

• Any behavior directed toward a child that
  endangers or impairs a childs physical or
  emotional health and development

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Types of Child Abuse

• physical abuse
• sexual abuse
• emotional abuse
• neglect

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Physical Abuse

• Physical abuse is any non-accidental injury to
  a child under the age of 18 by a parent or
  caretaker. These injuries may include beatings,
  shaking, burns, human bites, strangulation, or
  immersion in scalding water or others, with
  resulting bruises and welts, fractures, scars,
  burns, internal injuries or any other injuries.

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Physical Abuse (cont.)

• The term battered child syndrome was coined
  to characterize the clinical manifestations of
  serious physical abuse in young children.
• This term is generally applied to children
  showing repeated and devastating injury to the
  skin, skeletal system or nervous system. It
  includes children with multiple fractures of
  different ages, head trauma and severe visceral
  trauma, with evidence of repeated infliction.
• Another form is the The shaken infant. Shaking
  is a prevalent form of abuse seen in very young
  children (less than 1 year). Most perpetrators of
  such abuse are males. Intracranial haemorrhages,
  retinal haemorrhages and chip fractures of the
  childs extremities can result from very rapid
  shaking of an infant.

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Corporal Punishment

• Corporal punishment of children --- in the form
  of hitting, punching, kicking or beating --- is
  socially and legally accepted in most countries.
  In many, it is a significant phenomenon in
  schools and other institutions and in penal
  systems for young offenders.

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PSYCHOLOGICAL MALTREATMENTDefinition

• Psychological Neglect - the consistent failure of
  a parent or caretaker to provide a child with
  appropriate support, attention, and affection.
• Psychological Abuse - a chronic pattern of
  behaviors such as belittling, humiliating, and
  ridiculing a child.

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Emotional Abuse

• Emotional abuse includes the failure of a
  caregiver to provide an appropriate and
  supportive environment, and includes acts that
  have an adverse effect on the emotional health
  and development of a child.
• Such acts include restricting a childs
  movements, denigration, ridicule, threats and
  intimidation, discrimination, rejection and other
  nonphysical forms of hostile treatment.

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Neglect

• Neglect refers to the failure of a parent to
  provide for the development of the child where
  the parent is in a position to do so in one or
  more of the following areas health, education,
  emotional development, nutrition, shelter and
  safe living conditions.
• Neglect is thus distinguished from circumstances
  of poverty in that neglect can occur only in
  cases where reasonable resources are available to
  the family or caregiver.

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CHILD SEXUAL ABUSEDefinition
Child sexual abuse is the exploitation of a
child or adolescent for the sexual gratification
of another person.
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SEXUALLY ABUSIVE BEHAVIORS

• Sodomy
• Oral-genital stimulation
• Verbal stimulation
• Exhibitionism

• Voyeurism
• Fondling
• Child prostitution
• Child pornography
• Intercourse

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Three Major Components of Child Abuse
Child Care Giver Stress Child Abuse
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Who are at Risk
-Abuse most common in children lt 1 yr. old -Girls
more frequently abused at older age vs. boys
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The Extent of the Problem

• Fatal abuse
• According to the World Health Organization, there
  were an estimated 570 000 deaths attributed to
  homicide among children under 15 years of age in
  2000 around the world. Global estimates of child
  homicide suggest that infants and very young
  children are at greatest risk, and those who live
  in developing countries.
• Non-fatal abuse
• According to the WORLD REPORT ON VIOLENCE AND
  HEALTH by WHO among children in Egypt, 37
  reported being beaten or tied up by their parents
  and 16 reported physical injuries such as
  fractures, loss of consciousness or permanent
  disability as a result of being beaten or tied up.

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Rates of harsh or moderate forms of physical
punishment(WHO) WORLD REPORT ON VIOLENCE AND
HEALTH (2002)
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Rates of verbal or psychological punishment(WHO)
WORLD REPORT ON VIOLENCE AND HEALTH (2002)
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• Parental beliefs and reasons for punishment 
• Survey in Egypt showed lying, disrespect,
  disobedience, low performance in school and
  destroying property are the main reasons for
  punishment (Youseff and Kamel, 1998(

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Health Consequences of Child Abuse
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Health Consequences of Child Abuse(cont.)
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Role of Family Physician in Child Abuse

• Protect
• Suspect
• Inspect
• Collect
• Respect

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Protect...

• Patient/family and team safety are paramount.
• Protect the life of the patient as well as as
  much evidence as possible.

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Suspect...

• Does the history fit what you are seeing- either
  injury or illness?
• Is this a repeat patient or family member of a
  repeat patient?
• Is there a history of family violence?

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Collect...

• Collect as much evidence as possible, including
• physical and trace evidence
• information

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Respect...

• Respect the right to refuse
• Respect diversity
• Respect privacy

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The Cycle of Abuse...

• Family violence
• Abuser-to abuser cycle
• Factors in altering the cycle of violence

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Responsibilities to Report...

• Who must report
• Deciding to report
• A report of suspected child abuse is a
  responsible attempt to protect a child.

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Identifying Physical Abuse... By the Family Doctor

• Normal childhood development
• Conditions that may be confused with abuse
• Unintentional vs intentional injury

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Recognizing Abuse Injuries...

• Skin Injuries
• TEARS
• Human Bite Marks
• Hair Loss
• Falls
• Head, facial, oral injuries
• Shaken baby Syndrome

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Human Bites

• Strongly suggest abuse
• Easily overlooked
• Location of bite marks on infants differ from
  sites on older children

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Bruises

• Generally speaking
• fresh injury is red to blue
• 1-3 days deep black or purple
• 3-6 days color changes to green and then brown
• 6-15 days green to tan to yellow to faded, then
  disappears
• The younger the child the quicker the color
  resolves.

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Bruises
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Burns

• Abusive Burn Patterns
• Scald Immersion Splash Burns
• Flexion Burns
• Contact Burns
• Pseudoabusive Burns

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Burns
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Suspicious Fractures
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Falls

• In most cases, falls cause a minor injury.
• If a child is reported to have had a routine fall
  but has what appear to be severe injuries, the
  inconsistency of the history with the injury
  indicates child abuse.

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Head, Facial, Oral Injuries

• Head is a common area of injury.
• Approx. 50 of physical abuse patients have head
  or facial injuries.
• Injuries to the sides of the face, ears, cheeks,
  and temple area are highly suspicious for abuse.
• Mouth/lip/teeth injuries

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Indicators of Child Abuse (Discovered by Family
Doctor)
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• Common Features of Successful Child Abuse
  Prevention Programs ______________________________
  _________
• Strengthen family and community connections and
  support.
• Treat parents as vital contributors to their
  children's growth and development.
• Create opportunities for parents to feel
  empowered to act on their own behalf.
• Respect the integrity of the family.
• Enhance parents' capability to foster the optimal
  development of their children and themselves.
• Establish links with community support systems.
• Provide settings where parents and children can
  gather, interact, support and learn from each
  other.
• Enhance coordination and integration of services
  needed by families.
• Enhance community awareness of the importance of
  healthy parenting practices.

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National Initiatives to Eliminate Child Abuse

• PILOT PROJECTS
• ?? FGM Free Village Model to eliminate the
  practice of FGM in 120 villages in Upper Egypt.
• ?? Protection and Rehabilitation of Child Labor
  in selected squatter areas.
• ?? Empowerment of Adolescent Girls focusing on
  reproductive health awareness and knowledge
  dissemination
• ?? Protection of Youth From Substance Abuse to
  establish demand-reduction units and increase
  social awareness.
• ?? Protection of Children Against Delinquency
  to effectuate family courts and monitor its
  jurisdiction.
• ?? Protection of Street Children Against Drugs
  through monitoring protection institutions and
  building capacities of police officers and social
  workers.
• ?? Promote the Culture of Child Rights through
  raising awareness of school teachers with the
  child rights.

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FGM
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NATIONAL PROGRAM FOR THE ELIMINATION OF FGM ??
Trigger behavioral change. ?? Enhance rights of
the girl child with a focus on FGM. ?? Create NGO
and youth leaders advocacy network. ??
Incorporate regulatory provisions that condemn
FGM. ?? Implement a social marketing campaign and
produce an FGM-Free Village model toolkit.
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NATIONAL STRATEGY FOR PROTECTION, REHABILITATION
AND INTEGRATION OF STREET CHILDREN

• Ensure all rights of street children through
• ?? Changing the community's negative perception.
• ?? Building a comprehensive database.
• ?? Capacity building for cadres dealing with
  street children.
• ?? Introducing legal amendments and strengthening
  enforcement mechanisms.
• ?? Supporting NGOs caring for street children
  from drug abuse, violence and exploitation.
• ?? Demonstrating vocational, health and
  psychological rehabilitation services.
• ?? Expanding the social net programs and direct
  services for poor families to eradicate root
  causes of the problem.

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JUVENILE JUSTICE

• ?? Ensure protection of rights of children in
  conflict with the law.
• ?? Define criminal responsibility and penalty in
  proportion to child age.
• ?? Initiate measures to protect children against
  delinquency.
• ?? Monitor juvenile courts effectiveness.
• ?? Promote physical and psychological
  rehabilitation
• ?? Establish family friendly courts.

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Thank You